calca-protein--human and Pneumonia--Ventilator-Associated

Nosocomial pneumonia is a frequent and severe nosocomial infection divided in two distinct groups: hospital-acquired pneumonia and ventilator-associated pneumonia (VAP). In this context, the VAP is notoriously difficult to diagnose clinically, resulting from the lack of a 'gold standard' method of diagnosis.. The use of biomarkers may potentially improve the early diagnosis of infections allowing earlier and better identification and treatment. An exhausting list of biomarkers has been studied and although far from perfect, procalcitonin (PCT) and C-reactive protein (CRP) are the most studied biomarkers used in clinical practice. Data coming from literature suggests the use of PCT for VAP prognosis and as a based algorithm tool for the reduction of duration of pneumonia therapy, as well as, the use of the CRP dynamics to the early prediction of VAP and the response to the antibiotics.. The evidence for the use of biomarkers to diagnose nosocomial pneumonia as a stand-alone tool is low to moderate. Improved performance for both PCT and CRP can be obtained by using them in association with clinical features or scoring systems but prospective studies are still needed to validate this hypothesis.

Topics: Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cross Infection; Humans; Pneumonia; Pneumonia, Ventilator-Associated; Prospective Studies; Protein Precursors; Sensitivity and Specificity

This meta-analysis was performed to determine the accuracy of procalcitonin (PCT) in predicting mortality in pneumonia patients with different pathogenic features and disease severities. A systematic search of English-language articles was performed using PubMed, Embase, Web of Knowledge and the Cochrane Library to identify studies. The diagnostic value of PCT in predicting prognosis was determined using a bivariate meta-analysis model. The Q-test and I(2) index were used to test heterogeneity. A total of 21 studies comprising 6007 patients were included. An elevated PCT level was a risk factor for death from community-acquired pneumonia (CAP) (risk ratio (RR) 4.38, 95% confidence interval (CI) 2.98-6.43), particularly in patients with a low CURB-65 score. The commonly used cut-off, 0.5 ng/mL, had low sensitivity (SEN) and was not able to identify patients at high risk of dying. Furthermore, the PCT assay with functional SEN <0.1 ng/mL was necessary to predict mortality in CAP in the clinic. For critically ill patients, an elevated PCT level was associated with an increased risk of mortality (RR 4.18, 95% CI: 3.19-5.48). The prognostic performance was nearly equal between patients with ventilator-associated pneumonia (VAP) and patients with CAP.

Topics: Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Community-Acquired Infections; Critical Illness; Glycoproteins; Humans; Pneumonia; Pneumonia, Ventilator-Associated; Predictive Value of Tests; Prognosis; Protein Precursors; Risk Assessment

Procalcitonin's contribution to the diagnosis of nosocomial infection, particularly ventilator-associated pneumonia (VAP), is poor: its levels in patients with microbiologically documented VAP the day infection is diagnosed range from normal to extremely high. Moreover, the results of four studies showed that, despite relatively good specificity, this marker had low sensitivity for the diagnosis of VAP. However, because procalcitonin is well associated with outcome, its kinetics during antimicrobial therapy can be used to customize that treatment duration. Two recent studies showed that a procalcitonin-based strategy (recommending that treating physicians stop antibiotics when the procalcitonin concentration was <0.5 ng/mL, or had decreased by ≥80%) led to less antibiotic consumption by VAP patients, compared with a conventional strategy, with no adverse outcome. Accordingly, for VAP patients, procalcitonin may be used to stop antibiotics as early as day 3 after their initiation, if its concentration is <0.5 ng/mL or has decreased by ≥80%, compared with the first peak concentration.

Topics: Animals; Anti-Bacterial Agents; Calcitonin; Calcitonin Gene-Related Peptide; Drug Administration Schedule; Humans; Pneumonia, Ventilator-Associated; Protein Precursors; Sensitivity and Specificity; Time Factors

No currently available biomarker can be used as a diagnostic marker for ventilator-associated pneumonia due to multidrug-resistant pathogens. Procalcitonin can be used to customize the duration of antimicrobial treatment without excess morbidity and mortality: when its concentration is less than 0.5 ng/mL or has decreased by 80% or more compared with the peak concentration, antibiotics can be stopped. With this strategy, extreme vigilance must be maintained after terminating antimicrobial therapy to detect a recurrent infection.

Topics: Biomarkers; Bronchoalveolar Lavage Fluid; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Drug Resistance, Multiple, Bacterial; Humans; Membrane Glycoproteins; Pneumonia, Bacterial; Pneumonia, Ventilator-Associated; Protein Precursors; Receptors, Immunologic; Triggering Receptor Expressed on Myeloid Cells-1

The management of bloodstream infections especially sepsis is a difficult task. An optimal antibiotic therapy (ABX) is paramount for success. Procalcitonin (PCT) is a well investigated biomarker that allows close monitoring of the infection and management of ABX. It has proven to be a cost-efficient diagnostic tool. In Diagnoses Related Groups (DRG) based reimbursement systems, hospitals get only a fixed amount of money for certain treatments. Thus it's very important to obtain an optimal balance of clinical treatment and resource consumption namely the length of stay in hospital and especially in the Intensive Care Unit (ICU). We investigated which economic effects an optimized PCT-based algorithm for antibiotic management could have.. We collected inpatient episode data from 16 hospitals. These data contain administrative and clinical information such as length of stay, days in the ICU or diagnoses and procedures. From various RCTs and reviews there are different algorithms for the use of PCT to manage ABX published. Moreover RCTs and meta-analyses have proven possible savings in days of ABX (ABD) and length of stay in ICU (ICUD). As the meta-analyses use studies on different patient populations (pneumonia, sepsis, other bacterial infections), we undertook a short meta-analyses of 6 relevant studies investigating in sepsis or ventilator associated pneumonia (VAP). From this analyses we obtained savings in ABD and ICUD by calculating the weighted mean differences. Then we designed a new PCT-based algorithm using results from two very recent reviews. The algorithm contains evidence from several studies. From the patient data we calculated cost estimates using German National standard costing information for the German G-DRG system. We developed a simulation model where the possible savings and the extra costs for (in average) 8 PCT tests due to our algorithm were brought into equation.. We calculated ABD savings of 4 days and ICUD reductions of -1.8 days. Our algorithm contains recommendations for ABX onset (PCT ≥ 0.5 ng/ml), validation whether ABX is appropriate or not (Delta from day 2 to day 3 ≥ 30% indicates inappropriate ABX) and recommendations for discontinuing ABX (PCT ≤ 0.25 ng/ml). We received 278,264 episode datasets where we identified by computer-based selection 3,263 cases with sepsis. After excluding cases with length of stay (LOS) too short to achieve the intended savings, we ended with 1,312 cases with ICUD and 268 cases without ICUD. Average length of stay of ICU-patients was 27.7 ± 25.7 days and for Non-ICU patients 17.5 ± 14.6 days respectively. ICU patients had an average of 8.8 ± 8.7 ICUD. - After applying the simulation model on this population we calculated possible savings of Euro -1,163,000 for ICU-patients and Euro -36,512 for Non-ICU patients.. Our findings concerning the savings from the reduction of ABD are consistent with other publications. Savings ICUD had never been economically evaluated so far. Our algorithm is able to possibly set a new standard in PCT-based ABX. However the findings are based on data modelling. The algorithm will be implemented in 5-10 hospitals in 2012 and effects in clinical reality measured 6 months after implementation.. Managing sepsis with daily monitoring of PCT using our refined algorithm is suitable to save substantial costs in hospitals. Implementation in clinical routine settings will show how much of the calculated effect will be achieved in reality.

Topics: Algorithms; Anti-Bacterial Agents; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Computer Simulation; Critical Care; Diagnosis-Related Groups; Germany; Humans; Intensive Care Units; Length of Stay; Pneumonia, Ventilator-Associated; Protein Precursors; Sepsis

For treatment studies of an infectious disease, such as pneumonia, microbiologic eradication is the logical primary end point. Several problems for pneumonia in general and several more specific to VAP preclude the use of microbiologic eradication as a primary end point. These problems include no positive culture result at baseline, difficulty distinguishing colonization from infection on baseline cultures, no specimen available for testing when determining cure, and induction of colonization by antibiotic treatment. These problems have led to interest in serial quantitative cultures and biomarkers to determine the microbiologic outcome. Although promising, especially for open-label studies focused on multidrug-resistant pathogens, further research is needed before serial quantitative cultures can be used to define microbiologic failure. Of the biomarkers, procalcitonin level may be a valuable adjunct to clinical evaluation but cannot be a primary end point alone. A decreasing or low procalcitonin level after initiation of antibiotic treatment correlates well with bacterial eradication.

Topics: Anti-Bacterial Agents; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Clinical Trials as Topic; Cross Infection; Endpoint Determination; Hospitals; Humans; Pneumonia, Bacterial; Pneumonia, Ventilator-Associated; Protein Precursors; Treatment Outcome

This article reviews recent data on the usefulness of serum markers in community-acquired pneumonia and ventilator-associated pneumonia. The focus is on clinical studies, with an emphasis on adult critically ill patients.. Serum markers have demonstrated potential value in early prediction and diagnosis of pneumonia, in monitoring the clinical course and in guiding antibiotic therapy. C-reactive protein appears to perform better in diagnosing infection, because several studies have shown that procalcitonin may remain undetectable in some patients, specifically those with pneumonia. Procalcitonin exhibited a better correlation with clinical severity, however. Furthermore, one report demonstrated the efficacy and safety of procalcitonin-guided antibiotic therapy in community-acquired pneumonia.. Serum markers should only be used as a complementary tool to support the current clinical approach. Use of serum markers, in particular procalcitonin and C-reactive protein, represents a promising strategy in the clinical decision-making process in patients in whom pneumonia is suspected. Specifically, these markers can be used to guide culture sampling and empirical antibiotic prescription, and to monitor the clinical course, adjust the duration of antibiotic therapy and identify nonresponders, in whom an aggressive diagnostic and therapeutic approach may prevent further clinical deterioration.

Topics: Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Community-Acquired Infections; Humans; Membrane Glycoproteins; Pneumonia; Pneumonia, Ventilator-Associated; Protein Precursors; Randomized Controlled Trials as Topic; Receptors, Immunologic; Triggering Receptor Expressed on Myeloid Cells-1; Ventilators, Mechanical

The purpose of this review is to analyze the potential advantages and drawbacks of using biomarkers of bacterial infection for the diagnosis and prognosis of ventilator-associated pneumonia.. Whereas procalcitonin and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) have both greater diagnostic accuracies than most commonly used clinical parameters and other biomarkers of infection, such as C-reactive protein, they can be increased in noninfectious conditions or remain low in patients with true infection. Furthermore, these assays cannot determine the causative organisms and associated patterns of antibiotic susceptibility.. Procalcitonin and sTREM-1 should be used only as a complementary tool, to reinforce the usual diagnostic work-up. However, serial serum procalcitonin and sTREM-1 measurements may provide an opportunity to change the treatment early in the course of patients with ventilator-associated pneumonia, either to intensify treatment when their levels stay high, or to avoid unnecessary prolonged courses of antibiotics when their levels rapidly decrease. Whether procalcitonin and/or sTREM-1 guidance can reduce antibiotic use in such a setting will require additional studies, but such a strategy appears promising.

Topics: Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cross Infection; Drug Resistance, Bacterial; Humans; Membrane Glycoproteins; Pneumonia, Ventilator-Associated; Prognosis; Protein Precursors; Receptors, Immunologic; Triggering Receptor Expressed on Myeloid Cells-1

To investigate the preventive effects of thymosin-alpha1 against early ventilator-associated pneumonia (VAP) in the patients with mechanical ventilation.. Fifty two patients with expectancy of mechanical ventilation over 48 h were divided into routine therapy group (n=26) and thymosin therapy group (n= 26) in random. The patients in routine therapy group were given intensive care unit (ICU) conventional treatment, and the patients in thymosin therapy group were given thymosin treatment additionally (1.6 mg subcutaneous injection, qd X 7 d). The incidence and occurrence time of VAP were observed, and the time of mechanical ventilation and ICU stay were recorded. The levels of CD3+, CD4+, CD4+ /CD8+ T lymphocyte, CD14+ mononuclear cell human leukocyte antigens-DR (CD14+ HLA-DR) and procalcitonin (PCT) were detected before mechanical ventilation and at the 3d and 7th d after mechanical ventilation.. The base line including the level of immunologic function had no difference between the two groups (P>0.05). The incidence of VAP in thymosin therapy group was lower than that in routine therapy group, but it was not significant difference (P>0.05). The durations of machine ventilation and ICU stay in thymosin therapy group were shorter than those in routine therapy group (P<0.05). The occurrence time of VAP in thymosin therapy group was significantly later than that in routine therapy group (P<0.05). At the 3rd and 7th d after mechanical ventilation, thymosin therapy group achived higher levels of CD3+, CD4+, CD4+ /CD8+ T lymphocyte and CD14+ HLA-DR than routine therapy group did (P<0.05).. Thymosinal may be able to improve immunologic function and prevent the incidence of early VAP in the patients with mechanical ventilation.

Topics: Calcitonin; Calcitonin Gene-Related Peptide; Cholecalciferol; HLA-DR Antigens; Humans; Intensive Care Units; Lipopolysaccharide Receptors; Pneumonia, Ventilator-Associated; Protein Precursors; Respiration, Artificial; Thymalfasin; Thymosin

to investigate the role of combined Lipopolysaccharide-Binding Protein (LBP) and Procalcitonin (PCT) ) as prognostic marker of mortality in patients with Ventilator-Associated Pneumonia (VAP).. this prospective cohort study was held in ICU/HCU of Cipto Mangunkusumo hospital between 2006 to 2007 by taking the subjects consecutively. Thirty five patients with VAP were studied. For analysing the data, chi-square or its alternative Fisher exact test were used. Based on a previous study for evaluation, we used cut off pants of 5 ng/ml and 0.5 ng/ml for PCT and 30 µg/ml and 25 µg/ml for LBP after three-day and seven-day treatment respectively. Receiver operating curve was made to determine the sensitivity and specificity of PCT and LBP as infection markers.. 35 patients participated in this study. After three days of therapy, if the level of PCT >5 ng/mL and LBP >30 µg/mL the prognosis would be bad (p<0.05) with a sensitivity of 88.5%, specificity of 53.2% and AUC value 0.69. Poor prognosis was also found if after seven day therapy PCT level was >0.5 ng/mL and LBP level >25 µg/mL (p<0.05) with sensitivity of 96.3%, specificity of 66.7% and AUC value 0.81.. examination of combined PCT and LBP can be taken as a good prognostic markers to predict mortality in patients with VAP.

Topics: Acute-Phase Proteins; Adult; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Carrier Proteins; Chi-Square Distribution; Cohort Studies; Female; Humans; Male; Membrane Glycoproteins; Middle Aged; Pneumonia, Ventilator-Associated; Prognosis; Prospective Studies; Protein Precursors; ROC Curve; Severity of Illness Index

In patients with ventilator-associated pneumonia (VAP), guidelines recommend antibiotic therapy adjustment according to microbiology results after 72 h. Circulating procalcitonin levels may provide evidence that facilitates the reduction of antibiotic therapy. In a multicentre, randomised, controlled trial, 101 patients with VAP were assigned to an antibiotic discontinuation strategy according to guidelines (control group) or to serum procalcitonin concentrations (procalcitonin group) with an antibiotic regimen selected by the treating physician. The primary end-point was antibiotic-free days alive assessed 28 days after VAP onset and analysed on an intent-to-treat basis. Procalcitonin determination significantly increased the number of antibiotic free-days alive 28 days after VAP onset (13 (2-21) days versus 9.5 (1.5-17) days). This translated into a reduction in the overall duration of antibiotic therapy of 27% in the procalcitonin group (p = 0.038). After adjustment for age, microbiology and centre effect, the rate of antibiotic discontinuation on day 28 remained higher in the procalcitonin group compared with patients treated according to guidelines (hazard rate 1.6, 95% CI 1.02-2.71). The number of mechanical ventilation-free days alive, intensive care unit-free days alive, length of hospital stay and mortality rate on day 28 for the two groups were similar. Serum procalcitonin reduces antibiotic therapy exposure in patients with ventilator associated pneumonia.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Calcitonin; Calcitonin Gene-Related Peptide; Female; Guidelines as Topic; Humans; Male; Middle Aged; Pneumonia, Ventilator-Associated; Proportional Hazards Models; Protein Precursors; Time Factors; Treatment Outcome

To assess the predictive capacity for the diagnosis of ventilator-associated pneumonia (VAP) of serum procalcitonin levels before and on the day it is suspected.. Single-center observational study in the intensive care unit of a teaching hospital.. Consecutive patients whose serum procalcitonin levels were available on the day that VAP was clinically suspected (day 1) and at some time within the preceding 5 days ("before").. Serum procalcitonin levels were determined on day 1 and "before". Among the 73 suspected episodes VAP was confirmed by quantitative bronchoalveolar lavage cultures in 32 and refuted in 41. Respective median "before" procalcitonin levels were 1.89 ng/ml (interquartile range 0.18-6.01) and 2.14 (0.76-5.75) in patients with and without VAP, but their respective median day-1 procalcitonin levels did not differ: 1.07 ng/ml (0.39-6.57) vs. 1.40 (0.67-3.39). On day 1 a 0.5 ng/ml procalcitonin threshold had 72% sensitivity but only 24% specificity for diagnosing VAP. Between "before" and day 1, procalcitonin increased in 41% and 15% of patients with and without VAP, respectively. Thus a procalcitonin rise on day 1, compared to its "before" level, had 41% sensitivity and 85% specificity for diagnosing VAP, with respective positive and negative predictive values of 68% and 65%.. Crude values and procalcitonin rise had poor diagnostic value for VAP in this particular setting and thus should not be used to initiate antibiotics when VAP is clinically suspected.

Topics: Aged; Area Under Curve; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Intensive Care Units; Male; Middle Aged; Pneumonia, Ventilator-Associated; Protein Precursors; ROC Curve; Sensitivity and Specificity

The prognostic role of serum procalcitonin level in critically ill patients with ventilator-associated pneumonia was unclear. The aim of our study was to investigate the relationship between serum procalcitonin level and mortality risk in critically ill patients with ventilator-associated pneumonia.. Data of critically ill patients with ventilator-associated pneumonia were retrospectively collected. Demographics, comorbidities, and serum procalcitonin level were extracted from electronic medical records. The primary outcome was mortality within two months after diagnosis. Multivariable Cox regression analyses were performed to assess the prognostic role of serum procalcitonin level in those patients.. A total of 115 critically ill patients with ventilator-associated pneumonia were enrolled in our study. Serum procalcitonin level was not associated with age, gender, or other comorbidities. Univariate Cox regression model showed that high serum procalcitonin level was associated increased risk of morality within 2 months after diagnosis (OR = 2.32, 95% CI 1.25-4.31, P = 0.008). Multivariable Cox regression model showed that high serum procalcitonin level was independently associated increased risk of morality within 2 months after diagnosis (OR = 2.38, 95% CI 1.26-4.50, P = 0.008).. High serum procalcitonin level is an independent prognostic biomarker of mortality risk in critically ill patients with ventilator-associated pneumonia, and it's a promising biomarker of prognosis in critically ill patients.

Topics: Aged; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cohort Studies; Critical Illness; Demography; Female; Humans; Intensive Care Units; Male; Odds Ratio; Pneumonia, Ventilator-Associated; Prognosis; Proportional Hazards Models; Protein Precursors; Retrospective Studies; Risk

Undernutrition causes a reduction of body-fat mass and a decrease in the circulating concentration of leptin which impairs the production of proinflammatory cytokines and increases the incidence of infectious diseases. The main objective of this study was to determine whether leptin deficiency is a risk factor for ventilator-associated pneumonia (VAP).. This prospective observational case-control study was conducted in a university ICU during a 2-year period. Patients with VAP (cases) were matched (1:1) to patients without VAP (controls) according to all the following criteria: age, gender, SAPS II, and duration of ICU stay before VAP occurrence. In all patients leptin, C-reactive protein (CRP) and procalcitonin (PCT) were measured at ICU admission, and twice a week. In addition, in cases, leptin, CRP and PCT were also measured on the day of VAP diagnosis.. Eighty-six cases were matched with 86 controls. No significant difference was found in leptin and PCT levels between cases and controls. CRP level was significantly higher on the day of VAP in cases compared with controls (99 vs. 48 mg/L, P=0.001). Combination of CRP-leptin (CRP ≥78 mg/L and leptin ≥6.2 ng/mL on the day of VAP) was significantly (P=0.009) associated with VAP in univariate analysis. Multivariate analysis identified the combination of CRP-leptin (OR [95% CI] 3.08 [1.18-8.04], P=0.003), LOD score (1.27 [1.08-1.48], P=0.003), neuromuscular-blockers use (6.6 [2.03-21.7], P=0.002), and reintubation (3.3 [1.14-9.6], P=0.027) as independent risk factors for VAP.. In our study, leptin level was not associated with VAP occurrence. Further studies are needed to confirm our results, and to define the exact inflammatory role of leptin, and its interest as a biomarker in ICU patients.

Topics: Aged; Biomarkers; Body Mass Index; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Case-Control Studies; Female; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Hypoalbuminemia; Infection Control; Intensive Care Units; Leptin; Male; Malnutrition; Middle Aged; Pneumonia, Ventilator-Associated; Prospective Studies; Protein Precursors; Risk Factors; Sensitivity and Specificity; Ventilator Weaning

Autophagy is a highly conserved mechanism of eukaryotic cells implicated in cell homeostasis and elimination of intracellular pathogens. Functional polymorphisms in genes encoding for autophagy have been associated with susceptibility to inflammatory and infectious diseases, but data on severe infections are missing. The aim of the present study was to assess whether polymorphisms in genes encoding proteins involved in autophagy influence susceptibility to ventilator-associated pneumonia (VAP). Mechanically ventilated patients with VAP were studied. Genotyping for autophagy-related 16-like 1 (ATG16L1, rs2241880) functional polymorphism was performed using the TaqMan single-nucleotide assay. Monocytes were isolated from patients and stimulated with lipopolysaccharide (LPS). Tumor necrosis factor-α (TNF-α) was measured in the supernatants of monocytes using an enzyme-linked immunosorbent assay. Procalcitonin (PCT) was also measured in the serum of patients by an immuno-time-resolved amplified cryptate technology assay. A total of 155 patients with VAP were enrolled in the study. Carriage of the minor A allele of ATG16L1 was associated with septic shock with at least one organ failure (odds ratio (OR): 2.40, p: 0.036). TNF-α production was significantly greater among the carriers of the polymorphism presenting with at least one organ failure (p: 0.040). PCT was increased upon worsening to septic shock and organ failure only among carriers of the minor frequency A alleles. In a homogeneous cohort of septic patients with VAP, the carriage of autophagy polymorphisms predisposes to VAP severity and septic shock development. This may be related with predisposition to immunoparalysis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Autophagy-Related Proteins; Calcitonin; Calcitonin Gene-Related Peptide; Carrier Proteins; Female; Genetic Predisposition to Disease; Genotype; Genotyping Techniques; Humans; Male; Middle Aged; Pneumonia, Ventilator-Associated; Polymorphism, Genetic; Protein Precursors; Sepsis; Tumor Necrosis Factor-alpha; Young Adult

To facilitate the clinical diagnosis of ventilator-associated pneumonia (VAP) in the ICU, the Clinical Pulmonary Infection Score (CPIS) has been proposed but has shown a low diagnostic performance in subsequent studies. We propose a new score based on procalcitonin level and chest echography with the aim of improving VAP diagnosis: the Chest Echography and Procalcitonin Pulmonary Infection Score (CEPPIS).. This retrospective pilot study recruited patients admitted to the Intensive Care Unit of the Emergency Department, Careggi University Hospital (Florence, Italy), from January 2009 to December 2011. Patients were retrospectively divided into a microbiologically confirmed VAP group or a control group based on diagnosis of VAP and positive tracheal aspirate culture.. A total of 221 patients were included, with 113 in the microbiologically confirmed VAP group and 108 in the control group. A CEPPIS > 5 retrospectively fixed was significantly better in predicting VAP (OR, 23.78; sensitivity, 80.5%; specificity, 85.2%) than a CPIS > 6 (OR, 3.309; sensitivity, 39.8%; specificity, 83.3%). The receiver operating characteristic area under the curve analysis also showed a significantly higher diagnostic value for CEPPIS > 5 than CPIS > 6 (0.829 vs 0.616, respectively; P < .0001).. In this pilot, exploratory analysis, CEPPIS is effective in predicting VAP. Prospective validation is needed to confirm the potential value of this score to facilitate VAP diagnosis.

Topics: Aged; Analysis of Variance; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Case-Control Studies; Critical Care; Critical Illness; Female; Hospital Mortality; Humans; Intensive Care Units; Italy; Logistic Models; Male; Middle Aged; Pilot Projects; Pneumonia, Ventilator-Associated; Predictive Value of Tests; Prognosis; Protein Precursors; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Severity of Illness Index; Survival Analysis; Ultrasonography, Doppler

Ventilator-associated pneumonia (VAP) increases mortality in critical illness. However, clinical diagnostic uncertainty persists. We hypothesised that measuring cell-surface and soluble inflammatory markers, incorporating Triggering Receptor Expressed by Myeloid cells (TREM)-1, would improve diagnostic accuracy.. A single centre prospective observational study, set in a University Hospital medical-surgical intensive Care unit, recruited 91 patients into 3 groups: 27 patients with VAP, 33 ventilated controls without evidence of pulmonary sepsis (non-VAP), and 31 non-ventilated controls (NVC), without clinical infection, attending for bronchoscopy. Paired samples of Bronchiolo-alveolar lavage fluid (BALF) and blood from each subject were analysed for putative biomarkers of infection: Cellular (TREM-1, CD11b and CD62L) and soluble (IL-1β, IL-6, IL-8, sTREM-1, Procalcitonin). Expression of cellular markers on monocytes and neutrophils were measured by flow cytometry. Soluble inflammatory markers were determined by ELISA. A biomarker panel ('Bioscore'), was constructed, tested and validated, using Fisher's discriminant function analysis, to assess its value in distinguishing VAP from non VAP.. The expression of TREM-1 on monocytes (mTREM-1) and neutrophils (nTREM-1) and concentrations of IL-1β, IL-8, and sTREM-1 in BALF were significantly higher in VAP compared with non-VAP and NVC (p<0.001). The BALF/blood mTREM-1 was significantly higher in VAP patients compared to non-VAP and NVC (0.8 v 0.4 v 0.3 p<0.001). A seven marker Bioscore (BALF/blood ratio mTREM-1 and mCD11b, BALF sTREM-1, IL-8 and IL-1β, and serum CRP and IL-6) correctly identified 88.9% of VAP cases and 100% of non-VAP cases.. A 7-marker bioscore, incorporating cellular and soluble TREM-1, accurately discriminates VAP from non-pulmonary infection.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers; Bronchoalveolar Lavage Fluid; Calcitonin; Calcitonin Gene-Related Peptide; Case-Control Studies; CD11b Antigen; Female; Gene Expression; Humans; Intensive Care Units; Interleukin-1beta; Interleukin-6; Interleukin-8; L-Selectin; Male; Membrane Glycoproteins; Middle Aged; Monocytes; Neutrophils; Pneumonia, Ventilator-Associated; Predictive Value of Tests; Prospective Studies; Protein Precursors; Receptors, Immunologic; Triggering Receptor Expressed on Myeloid Cells-1

To assess the disease severity and prognosis value by observing the kinetic change of serum procalcitonin (PCT) and PCT clearance rate (PCTc) in the patients with ventilator associated pneumonia (VAP).. A single-center prospective observational study was conducted. A total of 128 patients with VAP admitted into intensive care unit (ICU) of First Affiliated Hospital of Xinjiang Medical University from February 2012 to June 2014 were enrolled. The patients were divided into recovery group (n=88) and deterioration group (n=40) according to the therapeutic outcome. The acute physiology and chronic health evaluation II (APACHEII) scores were estimated within 24 hours when VAP was diagnosed. The serum PCT (PCT1, PCT5, PCT7, PCT9) and PCTc (PCTc5, PCTc7, PCTc9) were examined at 1, 5, 7 and 9 days after the VAP was diagnosed. The diagnostic and predictive performance of PCT, PCTc and APACHEII scores were assessed by the receiver operating characteristic curve (ROC).. APACHEII scores in recovery group were significantly lower than those in the deterioration group (14.49 ± 5.30 vs. 18.90 ± 5.30, t=-4.349, P=0.000). There was no significant difference in PCT level (μg/L) at 1 day after VAP was diagnosed between recovery group and deterioration group [2.84 (0.81, 6.43) vs. 3.50 (0.97, 10.27), Z=-1.431, P=0.152]. With prolonged treatment, PCT was gradually decreased in recovery group, while remained at higher level in deterioration group, which was significantly lowered at 5 days after VAP diagnosed in recovery group compared with that in the deterioration group [1.28 (0.65,3.13) vs. 2.39 (0.78, 9.35), Z=-2.012, P=0.044]. PCTc maintained higher level in recovery group which was gradually increased with the improvement of the disease, and PCTc in deterioration group was lowered which was gradually decreased with the development of the disease. PCTc at 5, 7, 9 days in recovery group was significantly higher than that in deterioration group [5 d: 50.43 (20.39, 80.60)% vs. -56.68 (-286.28, 172.92)%, Z=-2.250, P = 0.024;7 d:54.01 (5.70, 102.30)% vs. -76.91(-335.03,181.21)%, Z=-2.561,P=0.010; 9 d:63.88(25.93, 101.80)% vs. -133.49(-547.20, 280.16)%, Z=-3.133,P=0.002]. The area under ROC curve (AUC) of PCT5, PCT7, PCT9 predicting the prognosis was 0.591, 0.683, 0.746, respectively [95% confidence interval (95% CI) was 0.456-0.726 (P=0.161), 0.557-0.808 (P=0.005), 0.631-0.860 (P=0.000)]. When PCT9 was 5.65 μg/L, the sensitivity of 95% and the specificity of 61%. The AUC of PCTc5, PCTc7 and PCTc9 was 0.648, 0.685, 0.729, respectively [95%CI was 0.513-0.783 (P=0.028), 0.555-0.815 (P=0.006), 0.607-0.851 (P=0.001)]. When PCTc9 was 92%, the sensitivity was 98% and the specificity was 71%. The AUC of APACHEII score was 0.693 (95% CI 0.578-0.808, P=0.003). When APACHEII score was 19.5, the sensitivity was 77% and the specificity was 58%.. The increased levels of PCT in patients with VAP were associated with the poor control of infection and may indicate the deterioration of VAP, it also can reflect the activity of lung infection in time. Keep observing the dynamic change of PCT and analyzing PCTc is more useful. The PCTc levels may provide evidence of disease progression and helpful in risk stratification in patients with VAP, and lower level of PCTc may accompany serious infection and predict poor prognosis.

Topics: APACHE; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Intensive Care Units; Pneumonia, Ventilator-Associated; Predictive Value of Tests; Prognosis; Prospective Studies; Protein Precursors; Treatment Outcome

To investigate the significance of optimization of bedside Gram staining of sputum smear in the early diagnosis and antimicrobial treatment for ventilator-associated pneumonia (VAP) patients.. The data of patients with VAP undergoing mechanical ventilation over 48 hours in the Department of Critical Care Medicine of Tianjin Fourth Central Hospital from June 2009 to June 2014 were analyzed. The patients were divided into two groups according to whether or not bedside Gram staining of sputum smear was used or not. The sputum samples from lower respiratory tract of all VAP patients were collected daily with tracheal catheter. In empirical examination group (from June 2009 to December 2011, n=43), the patients received antibiotics at the time of onset of VAP, selection of antibiotics depended on the information of bacterial epidemiology of the intensive care unit (ICU), and also existence of high risk factors of multi-drug resistant bacteria. In target treatment group (from January 2012 to June 2014, n=43), the patients received antibiotics according to the results of bedside instant sputum smear examination and empirical antibiotic regime. The correlation between the results of sputum smear examination and culture result was analyzed. The levels of body temperature, white blood cell (WBC) count, procalcitonin (PCT) level,and high sensitivity C- reactive protein (hs-CRP) were measured on the 1st day and 3rd day. The length of antibiotics treatment, duration of mechanical ventilation, and the time of ICU stay were recorded for both groups.. There were 512 qualified sputum specimens for culture, from which 336 pathogens were found, and 358 strains of pathogenic bacteria were found from microscopic examination of 512 qualified sputum smear. The coincidence rate of results of bedside examination of sputum smear and that of sputum culture was 78.32%(401/512). The diagnostic acumen of the former was 85.42% (287/336), specificity was 64.77% (114/176), positive predictive value was 80.17% (287/358), and negative predictive value was 74.03% (114/154). On the 1st day, no statistical differences in infection index between the two groups could be found, but on the 3rd day, the results were significantly improved in both groups. Compared with the empirical treatment group, the body temperature, WBC, PCT and hs-CRP in the target treatment group were significantly lower [body temperature (centigrade): 36.83 ± 0.69 vs. 37.64 ± 0.71, WBC (× 10⁹/L): 7.91 ± 2.75 vs. 9.66 ± 3.39, PCT (μg/L): 7.14 ± 3.89 vs. 10.14 ± 4.32, hs-CRP (mg/L): 12.24 ± 6.28 vs. 15.54 ± 5.94, P<0.05 or P<0.01]. Compared with the empirical treatment group, the time of antibiotics use(days: 6.00 ± 2.55 vs. 9.20 ± 3.46), the duration of mechanical ventilation (days: 5.00 ± 1.73 vs. 7.00 ± 1.94), and the length of ICU stay (days: 7.43 ± 1.72 vs. 12.57 ± 4.16) were significantly shortened (P<0.05 or P<0.01).. The results of bedside sputum examination and sputum culture showed a good correlation, and the former is helpful in early diagnosis and treatment of VAP. The result of high quality sputum smear in significant in guiding the first choice of antibiotics, reduce the time of antibiotic use, shorten the duration of mechanical ventilation and the length of ICU stay, and improve the outcome of the patients.

Topics: Anti-Bacterial Agents; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Early Diagnosis; Gentian Violet; Humans; Intensive Care Units; Phenazines; Pneumonia, Ventilator-Associated; Protein Precursors; Respiration, Artificial; Sputum; Staining and Labeling

Ventilator-associated pneumonia (VAP) is a significant problem in intensive care and there exists great demand for a suitable biomarker. Procalcitonin (PCT) has been proposed as a candidate marker.. To assess the clinical usefulness of monitoring PCT concentrations in non-surgical patients with early onset VAP.. Thirty-four patients were enrolled with early onset VAP defined as VAP diagnosed between 48 h and 6 days of the onset of mechanical ventilation. Serum PCT was measured on days 1, 2, 3, 5, 6 and 7.. The mortality rate was 21%. Non-survivors had significantly elevated PCT levels on days 3 and 7. For non-survival, the areas under the receiver operator curve (AUC) for PCT were 0.762 [95% confidence interval (CI): 0.6-0.923] on day 3 and 0.754 (95% CI: 0.586-0.922) on day 7. Among septic patients, PCT was significantly higher on days 1, 2, 3, 5, and 7, with the highest AUC on day 1 (0.783; 95% CI: 0.626-0.94): a cut-off of 1 ng/mL on day 1 had a positive predictive value of 0.813 for the development of septic shock.. No association was found between PCT concentration and the adequacy of antibiotic therapy or the aetiology of VAP. In logistic regression analysis, PCT was not significantly correlated with poor outcome. Although PCT levels were higher in non-survivors and those who developed septic shock, PCT is not a strong predictor of these outcomes.

Topics: Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Clinical Laboratory Techniques; Female; Humans; Male; Pneumonia, Ventilator-Associated; Prognosis; Protein Precursors; ROC Curve; Survival Analysis

Timely diagnosis and prognostic assessment of ventilator-associated pneumonia remain major challenges in critical care.. To explore the value of soluble triggering receptor expressed on myeloid cells 1, procalcitonin, and the Clinical Pulmonary Infection Score in the diagnosis and prognostic assessment of ventilator-associated pneumonia.. For 92 patients, bronchoalveolar lavage fluid was cultured for detection of microorganisms, serum levels of the receptor and procalcitonin and levels of the receptor in exhaled ventilator condensate were measured, and the Clinical Pulmonary Infection Score was calculated.. On the day of diagnosis, patients who had pneumonia had higher serum levels of the receptor, procalcitonin, and C-reactive protein; higher white blood cell counts; and higher pulmonary infection and Sequential Organ Failure Assessment scores than did patients without pneumonia. White blood cell count (odds ratio, 1.118; 95% CI, 1.139-1.204) and serum levels of the receptor (odds ratio, 1.002; 95% CI, 1.000-1.005) may be risk factors for VAP. Serum levels of the receptor plus the pulmonary infection score were the most reliable for diagnosis; the area under the receiver operating characteristic curve was 0.972 (95% CI, 0.945-0.999), sensitivity was 0.875, and specificity was 0.95. For 28-day survival, procalcitonin level combined with pulmonary infection score was the most reliable for prognostic assessment (area under the curve, 0.848; 95% CI, 0.672-1.025).. In patients with ventilator-associated pneumonia, serum levels of the receptor plus the pulmonary infection score are useful for diagnosis, and procalcitonin levels plus the pulmonary infection score are useful for prognostic assessment.

Topics: Breath Tests; Bronchoalveolar Lavage Fluid; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Critical Illness; Female; Humans; Intensive Care Units; Leukocyte Count; Male; Membrane Glycoproteins; Middle Aged; Multivariate Analysis; Odds Ratio; Pneumonia, Ventilator-Associated; Prognosis; Protein Precursors; Receptors, Immunologic; Risk Factors; ROC Curve; Sensitivity and Specificity; Sepsis; Severity of Illness Index; Triggering Receptor Expressed on Myeloid Cells-1

Ventilator-associated pneumonia (VAP) affects mortality, morbidity and cost of critical care. Reliable risk estimation might improve end-of-life decisions, resource allocation and outcome. Several scoring systems for survival prediction have been established and optimised over the last decades. Recently, new biomarkers have gained interest in the prognostic field. We assessed whether midregional pro-atrial natriuretic peptide (MR-proANP) and procalcitonin (PCT) improve the predictive value of the Simplified Acute Physiologic Score (SAPS) II and Sequential Related Organ Failure Assessment (SOFA) in VAP. Specified end-points of a prospective multinational trial including 101 patients with VAP were analysed. Death <28 days after VAP onset was the primary end-point. MR-proANP and PCT were elevated at the onset of VAP in nonsurvivors compared with survivors (p = 0.003 and p = 0.017, respectively) and their slope of decline differed significantly (p = 0.018 and p = 0.039, respectively). Patients with the highest MR-proANP quartile at VAP onset were at increased risk for death (log rank p = 0.013). In a logistic regression model, MR-proANP was identified as the best predictor of survival. Adding MR-proANP and PCT to SAPS II and SOFA improved their predictive properties (area under the curve 0.895 and 0.880). We conclude that the combination of two biomarkers, MR-proANP and PCT, improve survival prediction of clinical severity scores in VAP.

Topics: Adult; Aged; Atrial Natriuretic Factor; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Female; Gene Expression Regulation; Humans; Male; Middle Aged; Pneumonia, Ventilator-Associated; Prospective Studies; Protein Precursors; Regression Analysis; Risk; ROC Curve; Treatment Outcome

The intent of this study was to determine whether serum procalcitonin (PCT) levels are associated with prognosis, measured as organ dysfunctions and 28-day mortality, in patients with severe pneumonia.. This was a multicenter, observational study of critically ill adult patients with pneumonia requiring mechanical ventilation conducted in 10 academic hospitals in Canada, the United States, and Central Europe. PCT was measured daily for 14 days using an immuno-luminometric assay.. We included 175 patients, 57 with community acquired pneumonia (CAP), 61 with ventilator associated pneumonia (VAP) and 57 with hospital acquired pneumonia (HAP). Initial PCT levels were higher in CAP than VAP patients (median (interquartile range: IQR); 2.4 (0.95 to 15.8) vs. 0.7 (0.3 to 2.15), ng/ml, P < 0.001) but not significantly different to HAP (2.2 (0.4 to 8.0) ng/ml). The 28-day ICU mortality rate for all patients was 18.3% with a median ICU length of stay of 16 days (range 1 to 142 days). PCT levels were higher in non-survivors than in survivors. Initial and maximum PCT levels correlated with maximum Sequential Organ Failure Assessment (SOFA) score r2 = 0.50 (95% CI: 0.38 to 0.61) and r² = 0.57 (0.46 to 0.66), respectively. Receiver operating curve (ROC) analysis on discrimination of 28-day mortality showed areas under the curve (AUC) of 0.74, 0.70, and 0.69 for maximum PCT, initial PCT, and Acute Physiology and Chronic Health Evaluation (APACHE) II score, respectively. The optimal cut-off to predict mortality for initial PCT was 1.1 ng/ml (odds ratio: OD 7.0 (95% CI 2.6 to 25.2)) and that for maximum PCT was 7.8 ng/ml (odds ratio 5.7 (95% CI 2.5 to 13.1)).. PCT is associated with the severity of illness in patients with severe pneumonia and appears to be a prognostic marker of morbidity and mortality comparable to the APACHE II score.

Topics: Aged; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Canada; Community-Acquired Infections; Europe; Female; Humans; Intensive Care Units; Male; Middle Aged; Pneumonia; Pneumonia, Ventilator-Associated; Prognosis; Prospective Studies; Protein Precursors; Respiration, Artificial; Risk Assessment; Severity of Illness Index; Treatment Outcome; United States

Early and adequate treatment of ventilator-associated pneumonia (VAP) is mandatory to improve the outcome. The aim of this study was to evaluate, in medical ICU patients, the respective and combined impact of the Clinical Pulmonary Infection Score (CPIS), broncho-alveolar lavage (BAL) gram staining, endotracheal aspirate and a biomarker (procalcitonin) for the early diagnosis of VAP.. Prospective, observational study. A medical intensive care unit in a teaching hospital.. Over an 8-month period, we prospectively included 57 patients suspected of having 86 episodes of VAP.. The day of suspicion, a BAL as well as alveolar and serum procalcitonin determinations and evaluation of CPIS were performed.. Of 86 BAL performed, 48 were considered positive (cutoff of 10(4) cfu ml(-1)). We found no differences in alveolar or serum procalcitonin between VAP and non-VAP patients. Including procalcitonin in the CPIS score did not increase its accuracy (55%) for the diagnosis of VAP. The best tests to predict VAP were modified CPIS (threshold at 6) combined with microbiological data. Indeed, both routinely twice weekly performed endotracheal aspiration at a threshold of 10(5) cfu ml(-1) and BAL gram staining improved pre-test diagnostic accuracy of VAP (77 and 66%, respectively).. This study showed that alveolar procalcitonin performed by BAL does not help the clinician to identify VAP. It confirmed that serum procalcitonin is not an accurate marker of VAP. In contrast, microbiological resources available at the time of VAP suspicion (BAL gram staining, last available endotracheal aspirate) combined or not with CPIS are helpful in distinguishing VAP diagnosed by BAL from patients with a negative BAL.

Topics: Anti-Bacterial Agents; Biomarkers; Bronchoalveolar Lavage Fluid; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Intensive Care Units; Male; Middle Aged; Pneumonia, Ventilator-Associated; Prognosis; Prospective Studies; Protein Precursors; Sensitivity and Specificity; Severity of Illness Index

To evaluate the diagnostic value of procalcitonin (PCT) in ventilator-associated pneumonia (VAP).. Prospective study was performed. All adult patients who were admitted into the intensive care unit (ICU) of West China Hospital of Sichuan University between June 1st and October 1st and were clinically suspected of having developed VAP after 48 hours of mechanical ventilation were enrolled. Patients who had active infection or lung cancer at ICU admission or developed extrapulmonary infection during the study period were excluded. PCT and C-reactive protein (CRP) levels were measured and the clinical pulmonary infection score (CPIS) was calculated at study entry and on the day of VAP suspicion.. In total, 49 suspected episodes of VAP in 31 cases were microbiologically confirmed in 23 and refuted in 26. Median PCT levels were 0.68 microg/L (interquartile range 0.28, 2.31) and 0.18 microg/L (0.06, 0.28) respectively in patients with and without VAP on the suspicion day (P<0.01). Using 0.31 microg/L as the best cutoff, PCT had 73.9% sensitivity and 80.8% specificity. The CPIS resulted in higher sensitivity (95.7%) but lower specificity (53.8%) when the cutoff of CPIS > or = 5. CRP had the lowest sensitivity and specificity (56.5%, 61.5%) when the cutoff of CRP was 109.5 mg/L. A CPIS > or = 5 combined with serum levels of PCT > or = 0.31 microg/L did not improve the sensitivity (69.6%), but resulted in 88.5% specificity.. PCT had better specificity than CRP and CPIS in early diagnosis of VAP. Combined values of PCT and CPIS below the cut-off points could effectively exclude false-positive diagnosis of VAP.

Topics: Adult; Aged; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Early Diagnosis; Humans; Middle Aged; Pneumonia, Ventilator-Associated; Prospective Studies; Protein Precursors; Sensitivity and Specificity

The usefulness of procalcitonin (PCT) measurement in critically ill medical patients with suspected nosocomial infection is unclear. The aim of the study was to assess PCT value for the early diagnosis of bacterial nosocomial infection in selected critically ill patients.. An observational cohort study in a 15-bed intensive care unit was performed. Seventy patients with either proven (n = 47) or clinically suspected but not confirmed (n = 23) nosocomial infection were included. Procalcitonin measurements were obtained the day when the infection was suspected (D0) and at least one time within the 3 previous days (D-3 to D0). Patients with proven infection were compared to those without. The diagnostic value of PCT on D0 was determined through the construction of the corresponding receiver operating characteristic (ROC) curve. In addition, the predictive value of PCT variations preceding the clinical suspicion of infection was assessed.. PCT on D0 was the best predictor of proven infection in this population of ICU patients with a clinical suspicion of infection (AUROCC = 0.80; 95% CI, 0.68-0.91). Thus, a cut-off value of 0.44 ng/mL provides sensitivity and specificity of 65.2% and 83.0%, respectively. Procalcitonin variation between D-1 and D0 was calculated in 45 patients and was also found to be predictive of nosocomial infection (AUROCC = 0.89; 95% CI, 0.79-0.98) with a 100% positive predictive value if the +0.26 ng/mL threshold value was applied. Comparable results were obtained when PCT variation between D-2 and D0, or D-3 and D0 were considered. In contrast, CRP elevation, leukocyte count and fever had a poor predictive value in our population.. PCT monitoring could be helpful in the early diagnosis of nosocomial infection in the ICU. Both absolute values and variations should be considered and evaluated in further studies.

Topics: Aged; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Critical Illness; Cross Infection; Early Diagnosis; Female; Hospitals, Teaching; Humans; Intensive Care Units; Male; Middle Aged; Pneumonia, Ventilator-Associated; Predictive Value of Tests; Prospective Studies; Protein Precursors; ROC Curve

We investigated the role of the clinical pulmonary infection score (CPIS), serum levels of procalcitonin (PCT), C-reactive protein (CRP), and serum amyloid A (SAA) in the detection of patients with early ventilator-associated pneumonia (VAP).. Observational study in a university hospital. In 58 patients with severe brain injury receiving mechanical ventilation, CPIS, PCT, CRP and SAA were evaluated at ICU entry and at days 3 to 4 of hospital stay for VAP diagnosis (confirmed by endotracheal aspirate or BAL cultures).. We found the following: (1) PCT at entry was increased in patients who later had early VAP develop (25 patients) compared to no VAP (median, 1.4 ng/mL; 25-75 percentiles, 0.14-0.78; vs median, 0.2 ng/mL; 25-75 percentiles, 0.76-2.4, p<0.001; sensitivity, 76%; and specificity, 75%); (2) CPIS increased at the day of VAP diagnosis, compared to entry (median, 6.6+/-1.1 vs 1.5+/-1.1, p<0.001; sensitivity, 97%; specificity, 100%), while other serum inflammatory markers did not change; and (3) deterioration in oxygenation and changes in tracheal secretions were the main determinants of CPIS changes.. PCT may be a useful marker to predict which patients subsequently have early VAP. The CPIS could help as an early way to detect the patients with early VAP and who need further diagnostic testing.

Topics: Adult; Aged; Biomarkers; Brain Injuries; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Early Diagnosis; Female; Humans; Male; Middle Aged; Pneumonia, Ventilator-Associated; Prognosis; Protein Precursors; Retrospective Studies; Sensitivity and Specificity; Serum Amyloid A Protein; Ventilators, Mechanical

Diagnosis of ventilator-associated pneumonia (VAP) is difficult. The usefulness of high-sensitivity procalcitonin (ProCa-S) and high-sensitivity C-reactive protein (CRPH) in bronchoalveolar lavage (BAL) fluid and serum in the prediction of VAP was determined.. The study was conducted over a 28-month period (November 1999-June 2002) at the University Hospital Maastricht. BAL fluid samples were collected from patients admitted to the intensive care unit. Differential cell count and quantitative culture of BAL fluid were performed. C-reactive protein (CRP) and procalcitonin (PCT) on BAL fluid were determined by means of two high-sensitivity kits (CRPH and ProCa-S, respectively). Since both kits were designed for use on serum, validation for use on BAL fluid was performed.. A total of 117 patients were included. 43.6% (51/117) had microbiologically confirmed VAP. Both CRPH and ProCa-S showed good matrix effect, linearity and intra- and inter-assay variation. No significant differences in PCT and CRP concentrations in serum and BAL fluid were found between the VAP and the non-VAP group.. Both the ProCa-S and the CRPH kits can be used for assessing the concentration of PCT and CRP in BAL fluid, respectively. PCT and CRP concentrations in BAL fluid appeared to be of no additional value in the diagnosis of VAP.

Topics: Bronchoalveolar Lavage Fluid; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Pneumonia, Ventilator-Associated; Protein Precursors

This prospective, non-interventional study was conducted in a medical adult intensive care unit to determine the usefulness of procalcitonin (PCT) and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) determinations in the diagnosis of nosocomial sepsis. Serum PCT and bronchoalveolar lavage fluid sTREM-1 concentrations were measured in 50 critically ill patients suffering from nosocomial sepsis. Ventilator-associated pneumonia (VAP) was diagnosed in 31 patients and extrapulmonary sepsis in 19. Increase serum PCT concentration (>0.15 ng/ml) was found in 44 (88%) patients and was higher in those suffering from a non-pulmonary sepsis. The concomitant BAL sTREM-1 determination correctly classified pulmonary (VAP) versus non-pulmonary origin in 41 out of 44 cases (93%). Even when PCT concentration remained low, sTREM-1 assessment allowed for the detection of the sepsis (VAP) in 50% of cases. Both PCT and sTREM-1 concentrations were low in only 3 patients (6%) in whom sepsis could have been missed if only diagnosed by the measurement of these 2 biomarkers. We therefore concluded that the combined measurement of serum PCT and BAL sTREM-1 concentrations could be of interest in detecting the presence of a nosocomial sepsis and in discriminating VAP versus extrapulmonary infection.

Topics: Adult; Aged; Biomarkers; Bronchoalveolar Lavage Fluid; Calcitonin; Calcitonin Gene-Related Peptide; Cross Infection; Humans; Membrane Glycoproteins; Middle Aged; Pneumonia, Ventilator-Associated; Prospective Studies; Protein Precursors; Receptors, Immunologic; Sepsis; Triggering Receptor Expressed on Myeloid Cells-1